Musings of a Skeptic Oslerphile

A Doctor’s Touch: An Oslerphile’s Delight

First watch this TED Talk:

This talk touched upon one of the most important aspects of Medicine today. It is indeed a cruel irony that a profession so close to humanity is now so devoid of care for the very subject of its existence. While the issue with the iPatient may not be the main problem for a developing nation like India, we have our own bits and pieces of issues tagging into this.

While more and more technological innovations come in, the further becomes our distance from the patients. The healing touch is not just a mystic concept, it is a very important part of being a doctor. It is one of the things that keeps us connected with our patients. That reminds us how we are not just in charge of a syndrome or a diseased body/mind, but a human being as a whole. It reminds us that they have issues we often do not even contemplate in the maze of evidence based management we offer them for their presenting illnesses. How often do we discuss sexuality with patients suffering from advanced Multiple Sclerosis? How often do we bother about the socio-economic issues that has to go with treating a poor patient who earns his daily bread as a minimum wage laborer? How often do we try to improvise our medical advice learnt from books published in the United States of America to suit the needs of the family from India? How often do we address the fears and worries of the ICU patient, on a ventilator, but barely conscious, who sees another patient being given futile CPR right across the hall? How often do we try to understand why the teenage girl who presented to the ER with a drug overdose tried to “off herself” in the first place?

How often do we care about the patient as a human being? How often do we give a damn?

Medical education is designed to be objective. Obviously. It has to be, it is a curricular demand. It makes us view the entire human body in such mechanical terms that by the time we are well versed in the matter of the body, we end up being oblivious of the matter of the heart. I know this sounds a ridiculous proposition to my more evidence-minded colleagues, but the truth remains, despite everything medicine is (or claims to be) achieving now, we are slowly growing further apart from the patient.

I realize that AV’s talk has just caused an outpouring of emotions in me which I feel very strongly about. Clinical medicine is a dying art. When he talked of Auenbrugger discovering percussion, of Laennec using the Stethoscope and of course, of Conan Doyle’s teacher’s Holmesian powers of observations, it excites me. It reminds me of my teacher telling us about how to diagnose stuff just from handshakes. It reminds me of one my mentors, our very own Greg House, MD, diagnosing a patient with a recent cerebellar stroke just by watching the subtle changes in his gait.

Thank you Dr. Verghese, for reminding me that being a doctor is not always about treating the disease or diagnosing the syndromes, but also just about being there for someone who needs the care and attention of someone who understands, someone who empathizes…

6 thoughts on “A Doctor’s Touch: An Oslerphile’s Delight”

Though I have yet to know how objective and rigid the medical curriculum can be, I can only hope that I’m taught by people like Dr.Verghese, who understand the importance of, as you would put it, matters of the heart. Thanks for an informative and motivating post!

I don’t know the situation in your part of the world, but the problem is, most of my teachers were more interested in getting me to learn the factual side of Medicine. Some of them did a wonderful job, many did not, but except for one or two rare exceptions, no one taught us the magic of the HAND, as Dr. V puts it.

I wish you luck in that you get the best of teachers that remind you medicine is not just a trade, a vocation, but an art… 🙂

Thanks for caring to read the post and taking the time out to comment on it too!

Everyone has a different motivation, partlly based on the intrinsic personality one has, and partly molded by the circumstances one faces. The current circumstances in the practice of medicine, with its tread-mill like approach and emphasis on seeing as many patients as one can, are not at all conducive for developing any empathy. In modern day practice, empathy hardly ever translates into economic gains.
If at all, it has to be nurtured by individuals still believing in ideals not determined by economics…

The problem is more intense when it comes to the developing nations and countries like India (are we still a developing nation? What is the politically correct term for us?) where the doctor-patient ratio is skewed disastrously, especially in the rural areas.

One of the reasons I personally think is responsible for the vanishing humanity is the intense commercialization of the art of medicine. Unlike Osler once thought, it is a trade now.

One reads studies that qualitatively claim loss of empathy in medical students with progress through medical school and pooh pooh their findings thanks to their poor study structure. But it becomes rather hard to swallow the bitter pill reality hands us with…

Pranab. Even EBM’s final component is “The patient’s values and preferences”. And I guess that is probably forgotten a bit too often? EBM is not meant to make the whole process of health care a mechanical one. But one should not get carried away with the “technical parts” of EBM and stop there. Balancing is an art… and that needs some learning

I totally agree with you on this count.. Like we were discussing in our email discussion, physician paternalism is something that is at the base of the problem causing us to bypass the last step. Especially problematic is the situation for those doctors who train in peripheral Govt institutes where the average patient is illiterate or barely literate and considers the doctor to be the incarnation of God and lets us do whatever we want.

This habit, once formed early on in our lives, to assume that “you won’t understand… let me do my job” may make us render wonderful, evidence supported management of the case, but the real question is, will it let us ‘care’ for the patient?

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Pranab Chatterjee

Skeptic Oslerphile, Public Health Specialist and Program Manager, Translational Global Health Policy Research Cell, Ministry of Health and Family Welfare, Government of India; Scientist, Indian Council of Medical Research, National Institute of Cholera and Enteric Diseases. Past: Senior Research Associate, Public Health Foundation of India. Interests include: Emerging Infections, Public Health, Antimicrobial Resistance, One Health and Zoonoses, Diarrheal Diseases, Medical Education, Medical History, Open Access, Healthcare Social Media and Health2.0. Opinions are my own!
View all posts by Pranab Chatterjee

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